Comparison of transvaginal ultrasonography and saline infusion sonography for the detection of intracavitary abnormalities in premenopausal women

Objective To compare the diagnostic accuracy of transvaginal sonography (TV S) and saline infusion sonography ISIS) for detecting intracavitary abnorma lities in premenopausal women with abnormal uterine bleeding. Method Consecutive premenopausal women who underwent hysterectomy for abnor mal uterine bleeding were included. All women underwent TVS and SIS before their hysterectomy The findings at TVS and SIS were compared with the findi ngs of the hysterectomy specimen. Sensitivity, specificity, and likelihood ratios were calculated. Results The results of 50 patients with abnormal uterine bleeding were eval uated. Histological examination revealed normal endometrial histology in 27 patients, submucus myomas in 13 patients and intracavitary polyps in 10 pa tients. The sensitivity of TVS in directly visualizing intracavitary abnorm alities was 61% for a specificity of 96%. The likelihood ratio of presence of an intracavitary abnormality was 16 and the likelihood ratio of absence of such a finding was 0.41. When defining abnormality at TVS as direct visu alization of an intracavitary abnormality or an increased endometrial thick ness (cut-off level 5 mm), the. sensitivity of TVS was 87% for a specificit y of 56%, with corresponding likelihood ratios of 2 and 0.23, respectively. The sensitivity and specificity of SIS was 100% and 85% with likelihood ra tios of 6 and 0.0, respectively. No intracavitary abnormality was missed by SIS. Conclusion The diagnostic accuracy of SIS is higher than the accuracy of TV S. A combined approach using endometrial thickness measurement by TVS and, reserving SIS for patients with increased (> 5 mm) endometrial thickness, o r endometrium inadequately visualized on TVS, is the optimal method of redu cing the hysteroscopy rate.